|
Leukoplakia
Leukoplakia is a clinical term. The lesion is defined as a white patch or plaque, firmly attached to the oral mucosa, that cannot be classified as any other disease. It is a pre-cancerous lesion.
Cause - The exact etiology or cause remains unknown. Alcohol, tobacco, chronic local trauma, and Candida albicans are important predisposing factors.
Clinical features - Three clinical varieties are recognized: homogenous (common), speckled (less common), and verrucous (rare). Speckled and verrucous leukoplakia have a greater risk for malignant transformation than the homogenous type. The average percentage of malignant transformation for leukoplakia varies between 4% and 6%.
Laboratory tests - biopsy and histopathological examination
Treatment - Elimination of predisposing factors, systemic retinoid compounds. Surgical excision in the treatment of choice
Hairy Leukoplakia
Hairy leukoplakia is one of the most common and characteristic lesions of HIV infection. Rarely, it can also appear in immunosupressed patients after organ transplantation.
Cause - The Epstein-Barr virus seems to play a role in its pathogenicity.
Clinical Features - Hairy leukoplakia presents as a white asymptomatic, often elevated and unremovable patch. The lesion is almost always found bilaterally on the sides (lateral margins) of the tongue, and may spread to the top surfaces (dorsum) and bottom surfaces (ventral) of the tongue. Usually the surface of the lesion is corrugated with a vertical orientation. However, smooth and flat lesions may be seen. The lesion is not precancerous.
Treatment - Not required; however, in some cases, acyclovir may be used.
Lichen Planus
Lichen Planus is a relatively common chronic inflammatory condition of the oral mucosa and skin.
Cause - The cause is not well-known. It is believed that there is a T-cell mediated auto-immune process involved.
Clinical features - White papules that usually coalesce, forming a network of lines (Whickman's striae), are the characteristic oral lesions of the disease. Six forms of the disease are recognized in the oral mucosa: reticular or erosive (common), atrophic or hypertrophic (less common), bullous (rare). Middle-age individuals are more commonly affected (Men to women ratio 2:3). The inside of the cheeks, the tongue, and gums are the areas it tends to localize in. Skin lesions typically appear as polygonal purple papules. The prognosis is usually very good. Malignant transformation remains controversial.
Laboratory Tests - Biopsy and histopathological examination is often very helpful. Direct immunofluorecence may also be used.
Treatment - No treatment is needed in asymptomatic lesions. Topical steroids (ointment in Orabase, intralesional injection) may also be helpful. Systemic steroids in low doses can be used in severe and extensive cases. The topical use of antiseptic mouthwashes should be avoided.
Linea Alba
Linea alba is a relatively common alteration of the buccal mucosa (the inside of the cheeks).
Cause - Pressure; sucking from the cheek surface of the teeth.
Clinical features - It presents as an asymptomatic, bilateral, linear elevation with a slightly whitish color at the level of the occlusal line of the teeth. Diagnosis is based on clinical evaluation alone.
Treatment - No treatment is required.
Nicotine Stomatitis
Smoker's palate or nicotine stomatitis is a common tobacco related type of keratosis that exclusively occurs on the hard palate and is typically associated with pipe and cigar smoking.
Cause - It's the temperature, not the chemicals in the smoke that is responsible.
Clinical features - Clinically, the palatal mucosa responds initially with redness. Later it becomes wrinkled and takes on a diffuse whitish-gray color with numerous micronodules of inflamed and dilated salivary gland ducts. These lesions are not premalignant, in contrast to the "reverse smoker's palate," which is associated with reverse smoking.
Laboratory tests - Usually none are required.
Treatment - Smoking cessation
Chemical Burn
This is an injury to the oral mucosa caused by topical application of caustic agents.
Cause - Common causative agents include - hydrogen peroxide, aspirin and alcohol.
Clinical features - Clinically, the affected area is covered by a whitish membrane (due to necrosis/ cell death). The dead mucosa can be easily scrapped off, leaving a red bleeding surface. The lesions are painful. Diagnosis should be made on the basis of clinical features and history.
Treatment - purely symptomatic.
Candidiasis
Candidiasis is the most common oral fungal infection.
Cause - It is usually caused by Candida albicans, and less frequently by other fungal species. Predisposing factors include poor hygiene, xerostomia (dry mouth), dentures, antibiotic mouthwashes, broad-spectrum antibiotics, steroids, radiation, HIV infection, iron-deficiency anemia, and endocrine disorders.
Treatment - Topical antifungal agents (nystatin nd amphoteracin B), systemic azoles.
Chronic Biting
Mild chronic biting of the oral mucosa is relatively common in nervous individuals. These patients consciously bite the inside surface of their cheeks, lips and tongue and detach the superficial epithelial (skin) layers.
Clinical features - The lesions are characterized by a diffuse irregular white area of small furrows. Rarely, erosion and bruising may be seen. Diagnosis is made clinically.
Treatment - Encouragement to stop the habit.
Geographic Tongue
Geographic tongue is a relatively common benign condition, particularly affecting the tongue and rarely other oral mucosal sites.
Cause - Unknown.
Clinical Features - Clinically, the condition is characterized by multiple well demarcated, red, depapillated patches, typically surrounded by a slightly elevated whitish border and usually restricted to the dorsum (top) of the tongue. Usually the lesions persist for a short time in one area, then disappear completely and reappear in another area. The condition is usually asymptomatic and often coexists with fissured tongue. The diagnosis is made clinically.
Treatment - patient reassurance.
Hairy Tongue
Hairy tongue is a relatively common disorder that is due to marked accumulation of keratin on the filliform papillae of the tongue, resulting in a hair-like pattern.
Cause - Unknown. Predisposing factors include: poor oral hygiene, oxidizing mouthwashes, antibiotics, excessive smoking, emotional stress, radiation therapy, bacterial and fungal (Candida) infections.
Treatment - Elimination of predisposing factors. Tongue brushing and use of keratolytic agents.
Furred Tongue
Furred tongue is a relatively uncommon condition, usually appearing during febrile illness.
Cause - Unknown. Predisposing factors are febrile painful oral lesions, poor oral hygiene, dehydration, and a soft diet.
Clinical features - Clinically, it appears as a white or whitish-yellow thick coating on the surface of the tongue. The lesion is due to the lengthening of the filiform papillae (up to 3 to 4 mm) and accumulation of debris and bacteria. Usually, the condition appears and disappears within a short period of time. Diagnosis is made clinically.
Treatment - Therapy of the underlying illness and improvement of oral hygiene.
Material Alba
Material alba results from the accumulation of food debris, dead epithelial cells, and bacteria. It is common at the dentogingival margin.
Cause - poor oral hygiene
Clinical features - It presents as a soft whitish plaque that is easily detached after slight pressure.
Treatment - good oral hygiene
Fordyce's Granules
Fordyce's granules are ectopic sebacceous glands of the oral mucosa.
Cause - normal anatomical variation.
Clinical features - They present as multiple, asymptomatic, slightly raised whitish-yellow spots. The vermillion border of the upper lip and the insides of the cheeks are the common sites of predilection. They occur in about 80% of adults of both sexes.
Treatment - None required.
Leukoedema
Leukoedema is a normal anatomic variation.
Cause - It is due to increased thickness of the epithelium and intracellular edema (swelling) of the prickle-cell layer.
Clinical Features - Clinically, it is characterized by a grayish-white, opalescent pattern of the mucosa and a slightly wrinkling surface. It usually occurs bilaterally on the inside of the cheeks and rarely on the tongue and lips.
Treatment - None required.
White Spongy Nevus
White spongy nevus is a relatively rare inherited trait.
Clinical features - It presents as symmetrical white lesions with multiple furrows and a spongy texture. The lesions may appear at birth, or more commonly at early childhood. The insides of the cheeks and the surfaces under the tongue are the sites of predilection.
Treatment - None required.
Papilloma
Papilloma appears as a exophytic, painless, usually pedunculated growth. Characteristically the tumor has a white or normal color, with numerous finger-like projections that form a cauliflower pattern. Papilloma is usually solitary with an average size of 0.5 - 1cm.
Verrucous Carcinoma
Verrucous carcinoma is a low grade variant of squamous cell carcinoma. Presumably, human papillomavirus is involved in the pathogenesis.
Clinical Features - Clinically, it presents as a white mass with a pebbly surface. The size varies from 1cm in the early stages to very extensive lesions. The cheek, palate and gums are the most common sites of involvement. The condition mainly develops in smokers over the age of 60.
Laboratory tests - biopsy.
Treatment - Surgical excision.
Squamous Cell Carcinoma
Squamous cell carcinoma has a wide spectrum of clinical features. In about 5% to 8% of cases, it appears in the early stages as a white, asymetric plaque similar to leukoplakia. Biopsy and histopathological examination are important for the diagnosis in these cases.
|
